Provider Demographics
NPI:1740303833
Name:ABANG, ROBERT OWAN JR (LPN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:OWAN
Last Name:ABANG
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4659 W 150TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-3461
Mailing Address - Country:US
Mailing Address - Phone:216-205-4151
Mailing Address - Fax:
Practice Address - Street 1:4659 W 150TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-3461
Practice Address - Country:US
Practice Address - Phone:216-205-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH120761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse